Fig 1.
Eligibility criteria applied in the systematic review.
Fig 2.
Flow of studies through the review.
APA = American psychological association; n = number; WoS = web of science.
Fig 3.
Within-group syntheses - Effect direction plot of antipsychotics on appetite sensations.
a = unvalidated measurement scale; b = collective scale (i.e., measured appetite and food craving or eating cognitions collectively). BMI = Body mass index; EAS = Eating Apppetite Scale/Eating Attitude Scale; EBA = Eating Behavior Assessment; FCI = Food Craving Inventory; FCI-SP = Food Craving Inventory-Spanish Version; n = number; NA = not applicable; NR = not reported; NW = normal weight; OWO = overweight/obese; PARS = Platypus Appetite Rating Scale; RCT = randomised controlled trial; VAS = Visual analogue scale. Effect direction: upward arrow ▲ = positive effect; downward arrow ▼ = negative effect; sideways arrow ◄► = no change/mixed effect. Sample size: large arrow ▲ ≥ 300; medium arrow ▲ ≥ 100; small arrow ▲ 50-99; very small arrow ▲ < 50. Overall quality of evidence: ⊕⃝⃝⃝ very-low quality; ⊕⊕⃝⃝ low quality.
Fig 4.
Within-group syntheses - Effect direction plot of antipsychotics on food intake and dietary composition.
BMI = body mass index; g = grams; kcal = kilocalories; n = number; NA = not applicable; RCT = randomised controlled trial. Effect direction: upward arrow ▲ = positive effect; downward arrow ▼ = negative effect; sideways arrow ◄► = no change/mixed effect. Sample size: large arrow ▲ ≥ 300; medium arrow ▲ ≥ 100; small arrow ▲ 50-99; very small arrow ▲ < 50. Overall quality of evidence: ⊕⃝⃝⃝ very-low quality.
Fig 5.
Within-group syntheses - Effect direction plot of antipsychotics on eating cognitions and behaviours.
BMI = body mass index; n = number; NA = not applicable; NR = not reported; TFEQ = Three-Factor Eating Questionnaire; TFEQ-R21 = Three-Factor Eating Questionnaire-Revised 21-item Version; RCT = randomised controlled trial. Effect direction: upward arrow ▲ = positive effect; downward arrow ▼ = negative effect; sideways arrow ◄► = no change/mixed effect. Sample size: large arrow ▲ ≥ 300; medium arrow ▲ ≥ 100; small arrow ▲50-99; very small arrow ▲ < 50. Overall quality of evidence: ⊕⃝⃝⃝ very-low quality.
Fig 6.
Within-group syntheses GRADE Summary of Findings Table.
BMI = body mass index; n = number; RCT = randomised controlled trial; TFEQ = Three-Factor Eating Questionnaire.
Fig 7.
Between-group syntheses - Effect direction plot of antipsychotics on appetite sensations. a = unvalidated measurement scale.
BMI = body mass index; FCI = Food Craving Inventory; FGA = first-generation antipsychotic; n = number; NA = not applicable; RCT = randomised controlled trial; SQ = satiety quotient; SGA = second-generation antipsychotic; VAS = Visual analogue scale. Effect direction: upward arrow ▲ = positive effect; downward arrow ▼ = negative effect; sideways arrow ◄► = no change/mixed effect. Sample size: large arrow ▲ ≥ 300; medium arrow ▲ ≥ 100; small arrow ▲ 50-99; very small arrow ▲ < 50. Overall quality of evidence: ⊕⃝⃝⃝ very-low quality; ⊕⊕⃝⃝ low quality.
Fig 8.
Between-group syntheses - Effect direction plot of antipsychotics on food intake and dietary composition.
AP = antipsychotic; BMI = body mass index; EPIC = European Prospective Investigation into Cancer and Nutrition Questionnaire; FFQ = food frequency questionnaire; FGA = first-generation antipsychotic; kcal = kilocalories; MUFA = monounsaturated fatty acids; n = number; NA = not applicable; PUFA = polyunsaturated fatty acids; RCT = randomised controlled trial; SFA = saturated fatty acids; SGA = second-generation antipsychotic. Effect direction: upward arrow ▲ = positive effect; downward arrow ▼ = negative effect; sideways arrow ◄► = no change/mixed effect. Sample size: large arrow ▲ ≥ 300; medium arrow ▲ ≥ 100; small arrow ▲ 50-99; very small arrow ▲ < 50. Overall quality of evidence: ⊕⃝⃝⃝ very-low quality.
Fig 9.
Between-group syntheses - Effect direction plot of antipsychotics on the odds of developing eating disorders. a: Mean (SD) BMI of SGA-treated group mean = 32.90 (6.10), unexposed group = 33.80 (4.90). b: Mean (SD) BMI of SGA-treated group = 23.60 (2.20), unexposed group = 21.10 (2.50).
AP = antipsychotic; BED = binge eating disorder; BMI = body mass index; DSM-IV = Diagnostic and Statistical Manual of Mental Disorders, 4th Edition; EAT-26 = Eating Attitude Test; FGA = first-generation antipsychotic; n = number; NA = not applicable; NR = not reported; RCT = randomised controlled trial; SGA = second-generation antipsychotic. Effect direction: upward arrow ▲ = positive effect; downward arrow ▼ = negative effect; sideways arrow ◄► = no change/mixed effect. Sample size: large arrow ▲ ≥ 300; medium arrow▲ ≥ 100; small arrow ▲ 50-99; very small arrow ▲ < 50. Overall quality of evidence: ⊕⃝⃝⃝ very-low quality.
Fig 10.
Between-group syntheses - Effect direction plot of antipsychotics on eating cognitions and behaviour.
a: Mean (SD) BMI of SGA-treated group mean = 32.90 (6.10), unexposed group = 33.80 (4.90). b: Mean (SD) BMI of SGA-treated group = 23.60 (2.20), unexposed group = 21.10 (2.50). AP = antipsychotic; BMI = body mass index; DEBQ = Dutch Eating Behavior Questionnaire; FGA = first-generation antipsychotic; MAC-R = Revised version of the Mizes Anorectic Cognitions questionnaire; n = number; NA = not applicable; SGA = second-generation antipsychotic; TFEQ = Three-Factor Eating Questionnaire; TFEQ-R21 = Three-Factor Eating Questionnaire-Revised 21-Item Version. Effect direction: upward arrow ▲ = positive effect; downward arrow ▼ = negative effect; sideways arrow ◄► = no change/mixed effect. Sample size: large arrow ▲ ≥ 300; medium arrow ▲ ≥ 100; small arrow ▲ 50-99; very small arrow ▲ < 50. Overall quality of evidence: ⊕⃝⃝⃝ very-low quality.
Fig 11.
Between-group syntheses GRADE Summary of Findings Table.
BMI = body mass index; FGA = first-generation antipsychotic; n = number; RCT = randomised controlled trial; SGA = second-generation antipsychotic.
Fig 12.
Visual presentation of the thematic framework.
AP = antipsychotic medications.
Table 1.
GRADE-CERQual summary of qualitative findings.